Some years ago there was a discussion about whether someone born with a serious disorder of the external sex organ could have a satisfac­tory sex life as an adult. When a survey was conducted among adult men with an ‘open’ bladder (exstrofia vesicae) and the accompanying seriously abnormal (short) penis, it was found that seven of the eleven were satisfied with the way they functioned sexually, though the other four were clearly not. There is very little research of this kind to be found in the scientific literature.

In his posthumously published diaries, The Business of Living, the Italian writer Cesare Pavese (1908-1950) describes his own life as a lost battle. Pavese was impotent because of a congenital defect in his sex organ. He talks of a struggle with his own character, which over the years he came to regard as an insurmountable fate. When Pavese put an end to his life in 1950, it was the culmination of something he had been heading towards for years. There has been much conjecture and much has been written about why he committed suicide: criticism and misunderstanding from the Communists, the fact that no woman was prepared to commit herself to him, but mainly his sexual problems.

A few fragments from the diaries:

7 December 1937: A man who has not come up against the barrier of some physical impossibility that affects his whole life (impotence, dyspepsia, asthma, imprisonment, etc.) does not know what suffering is. In fact, such causes bring him to a decision of renouncement: a despairing attempt to make a virtue out of what is, any case, inevitable. Could anything be more contemptible?

23 December 1937: The child who passes his days and nights among men and women, knowing vaguely but not believing that this is reality, troubled, in short, that sex should exist at all, does he not foreshadow the man who spends his time among men and women, knowing, believing this is the only reality, suffering atrociously from his own mutilation? This feeling that my heart is being torn out and plunged into the depths, this giddiness that rends my breast and shatters me, is something I did not experience even when I was befooled in April.

The fate reserved for me (like the rat, my boy!) was to let the scar heal over, and then (with a breath, a caress, a sigh) to have it torn open again and a new infection added.

Neither deception nor jealousy have ever given me this vertigo of the blood. It took impotence, the conviction that no woman ever finds pleasure with me, or ever would. We are as we are; hence this anguish. If nothing else, I can suffer without feeling ashamed: my pangs are no longer those of love. But this, in very truth, is pain that destroys all energy: if one is not re­ally a man, if one must mix with women without being able to think of possessing them, how can one sustain one’s spirits and vital power? Could a suicide be better justified?

25 December 1937: If screwing was not the most important thing in life, Genesis would not have started with it.

Naturally everybody says to you ‘What does it matter? That’s not the only thing. Life is full of variety. A man can be good for something else,’ but no one, not even the men, will look at you unless you radiate that power. And the women will say to you: ‘What does it matter,’ and so on, but they marry someone else. And to marry means building a whole life, a thing you will never do. Which shows you have remained a child too long.